NATIONAL TB

PROGRAM
WHAT IS TUBERCULOSIS?

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2,500,000
Filipinos are affected with Tuberculosis

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 FACTS!
◎ TB is more prevalent among males compared to
females and among the 25 – 55 year old age
group.
◎ Tuberculosis is a major public health problem in
the Philippines. In 2010, TB was the 6th leading
cause of mortality with a rate of 26.3 deaths for
every 100,000 population and accounts for
5.1% of total deaths.1 This is slightly lower than
the five-year average of 28.6 deaths per
100,000 population. More males died (17,103)
compared to females (7,611).

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 FACTS!
◎ It is the sixth leading cause of
death and illness, with at least
60 Filipinos dying every day
from TB, and inflicts huge costs
to the family household and
Philippines economy.

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 1
WHAT IS THE NATIONAL
TB PROGRAM?
AFFILIATION OF THE GOVERNMENT
TOWARDS PEOPLE

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OBJECTIVES AND STRATEGIES

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RA 10767 : Comprehensive TB
Elimination Plan Act of 2016
A Journey in Eradicating TB in the
Philippines

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 STRATEGIES
◎ Activate communities and
patient groups to promptly
access quality TB services
◎ Collaborate with other
government agencies to reduce
out-of-pocket expenses and
expand social protection
programs
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 STRATEGIES
◎ Harmonize local and national
efforts mobilize adequate and
competent human resources
◎ Innovate TB information
generation and utilization for
decision making
◎ Enforce standards on TB care
and prevention and use of
quality products 10
 STRATEGIES
◎ Harmonize local and national
efforts mobilize adequate and
competent human resources
◎ Innovate TB information
generation and utilization for
decision making
◎ Enforce standards on TB care
and prevention and use of
quality products 11
 STRATEGIES
◎ Value clients and patients
through integrated patient-
centered TB services
◎ Engage national, regional and
local government units/
agencies on multi-sectoral
implementation of TB
elimination plan
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WHAT IS NATIONAL TB
CONTROL PROGRAM?

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PROGRAM COMPONENTS

◎ Health ◎ Regulation
Promotion ◎ Service Delivery
◎ Financing and ◎ Governance
Policy
◎ Human Resource
◎ Information
System

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 KEY INITIATIVES OF NTP
1. Public-private mix 2. Enhanced hospital
DOTS (PPMD) TB-DOTS
◎ Engagement of the ◎ Strengthening of the
private sector such as internal and external
private practitioners, referral systems and
pharmacies, and quality of TB
hospitals to adopt diagnosis and
the NTP policies and treatment in
guidelines and, hospitals.
hence, support the
TB control efforts.

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 KEY INITIATIVES OF NTP
3. Programmatic 4. TB in jails/prisons
Management of ◎ Ensuring access to TB
Drug-resistant TB diagnosis and treatment
(PMDT) by the inmates of jails
◎ Provision of diagnostic and prisons.
and treatment services
to drug-resistant TB
through the treatment
centers, satellite
treatment centers and
treatment sites.

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 KEY INITIATIVES OF NTP
5. TB-DOTS 6. Expansion of TB
certification and laboratory services
accreditation ◎ Enabling better access
◎ Ensuring the provision to TB microscopy
of quality TB services services through the
and generating financial establishment of more
support through the TB microscopy centers
PhilHealth TB-DOTS
outpatient benefit
such as those in the
package. hospitals and in the
private sector.

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 KEY INITIATIVES OF NTP
7. Community TB care
◎ Ensuring community participation to improve TB diagnosis
and management.

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 TB
SCORING
 DIRECT SPUTUM SMEAR
MICROSCOPY (DSSM)
◎ Fundamental to the detection
of infectious cases and is
recommended for case finding
among adults and children who
can expectorate.

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 DIRECT SPUTUM SMEAR
MICROSCOPY (DSSM)
◎ It is the primary diagnostic
method adopted by the NTP
among such individuals
because:
◉ 1. It provides a definitive
diagnosis of active TB
◉ 2. The procedure is simple

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TESTING FOR TB
Procedures on detecting
Tuberculosis

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 DIRECT SPUTUM SMEAR
MICROSCOPY (DSSM)
◎ It is the primary diagnostic
method adopted by the NTP
among such individuals
because:
◉ 3. It is economical
◉ 4. A microscopy center
could be put up even in
remote areas.
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 DIRECT SPUTUM SMEAR
MICROSCOPY (DSSM)

◎ Serves as one of the bases for

categorizing TB cases
according to standard case
definition.

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 DIRECT SPUTUM SMEAR
MICROSCOPY (DSSM)
◎ Used to:
◉ Monitor progress of patients
with TB while they are on
anti– TB treatment
◉ Confirm cure at the end of
treatment.

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Culturing and testing for drug
susceptibility
◎ TB culture and drug
susceptibility test (DST) using
solid or liquid media is a routine
diagnostic test for drug-
resistant TB cases under the
NTP.

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 TUBERCUlin skin test
◎ basic screening tool for TB
infection among children using
purified protein derivative
(PPD) tuberculin solution to
trigger a delayed
hypersensitivity reaction among
those previously infected.

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 TUBERCUlin skin test
◎ Also known as the PPD test or
Mantoux test, it is one of the
criteria used in determining
disease activity among children

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 Drugs Against TB
Issued drugs through TB DOTS
Program

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ISONIAZID

◎ is an antibiotic.
◎ MOA: inhibits the synthesis of
mycoloic acids in susceptible
bacteria which results in loss of
acid-fastness and disruption of
bacterial cell wall. At
therapeutic levels, it is
bacteriocidal against actively
growing intracellular and
extracellular Mycobacterium
tuberculosis organisms.

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RIFAMPICIN

◎ Anti-biotic
◎ MOA: suppresses initiation
of chain formation for RNA
synthesis in susceptible
bacteria by binding to the β
subunit of DNA-dependent
RNA polymerase, thus
blocking RNA
transcription.

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Pyrazinamide

◎ Anti-biotic : Stops the

growth of bacteria
◎ lowers the pH of the
environment below that
which is necessary for
growth
of Mycobacterium
tuberculosis

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Ethambutol

◎ Anti-biotic : Stops the

growth of bacteria
◎ Bacteriostatic against
susceptible bacteria.

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Streptomycin

◎ Anti-bacterial
◎ Inhibits bacterial protein
synthesis by binding
directly to the 30S
ribosomal subunits
causing faulty peptide
sequence to form in the
protein chain.

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 PHASES OF
TREATMENT
Intensive and Continuation Phase of
treatment of NTP

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 PHASES OF TREATMENT

◎ INTENSIVE ◎ CONTINUATION
◉ 2 months of ◉ 4 months of
isoniazid (INH), INH and RIF
rifampin (RIF),
pyrazinamide
(PZA), and
ethambutol
(EMB)

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TB TREATMENT
or ITP CARD
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Roles and Functions of
Collaborating Agencies

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Roles and Functions of
Collaborating Agencies

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Roles and Functions of
Collaborating Agencies

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Roles and Functions of
Collaborating Agencies

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Roles and Functions of
nurse

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CLASSIFICATION OF TUBERCULOSIS
DISEASE

• Classification based on bacteriological

status
Bacteriologically-confirmed – A TB patient from
whom a biological specimen is positive by smear
microscopy, culture or rapid diagnostic tests
(such as Xpert MTB/RIF).

Clinically-diagnosed – A PTB patient who does

not fulfill the criteria for bacteriological
confirmation but has been diagnosed with active
TB by a clinician or other medical practitioner
who has decided to give the patient a full course
of TB treatment. This definition includes cases
diagnosed on the basis of CXR abnormalities or
suggestive histology, and extra-pulmonary cases
without laboratory confirmation.
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CLASSIFICATION OF TUBERCULOSIS
DISEASE

• Classification based on anatomical site

Pulmonary TB (PTB) – Refers to a case of tuberculosis
involving the lung parenchyma. A patient with both pulmonary and
extra-pulmonary TB should be classified as a case of pulmonary
TB.
Extra-pulmonary TB (EPTB) – Refers to a case of
tuberculosis involving organs other than the lungs (e.g., larynx,
pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and
bones, meninges). Histologically-diagnosed EPTB through biopsy
of appropriate sites will be considered clinically-diagnosed TB.
Laryngeal TB, though likely sputum smear-positive, is considered
an extrapulmonary case in the absence of lung infiltrates on CXR.

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Classification based on history of
previous treatment

◎ New case ◎ Retreatment

– A patient who has case
never had treatment – A patient who has
for TB or who has been previously
taken antiTB drugs treated with anti-TB
for less than one ( drugs for at least
one (1) month in the
past.

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Classification based on drug-
susceptibility testing
1.Monoresistant-TB – Resistance to one first-line anti-TB
drug only. 2. Polydrug-resistant TB – Resistance to more
than one first-line anti-TB drug (other than both Isoniazid
and Rifampicin).
3. Multidrug-resistant TB (MDR-TB) – Resistance to at
least both Isoniazid and Rifampicin.
4.Extensively drug-resistant TB (XDR-TB) – Resistance to
any fluoroquinolone and to at least one of three second-
line injectable drugs (Capreomycin, Kanamycin and
Amikacin), in addition to multidrug resistance.
5. Rifampicin-resistant TB (RR-TB) – Resistance to
Rifampicin detected using phenotypic or genotypic
methods, with or without resistance to other antiTB drugs.
It includes any resistance to Rifampicin, whether
monoresistance, multidrug resistance, polydrug resistance
or extensive drug resistance. 52
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Thank You!

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